Have you ever asked a friend “How do you know you’re doing a Kegel correctly?” and they’ve suggested practicing by stopping the flow of urine while you’re on the toilet? It is true that in order to stop the flow of urine, you have to utilize the contraction of your pelvic floor muscles. However, this is not a good idea to put into practice.
The pelvic floor and your bladder are communicating throughout the day. When the pelvic floor is toned, the detrusor muscle (the muscle that contracts the bladder during emptying) is relaxed and vice versa, when the detrusor contracts to empty the bladder, the pelvic floor relaxes so urine can come out. When you are going about your daily business, your pelvic floor has a certain amount of resting tone which allows you to function and not be continuously leaking while the bladder slowly fills. When the bladder becomes around ⅔ full or so, it sends a signal to your brain that says: “Hey, excuse me brain but I’m going to have to empty soon”. You should then have control over your bladder and basically say: “Ok bladder, I hear you. I’m busy right now but I’ll go soon”. Then, the time comes when the bladder fills more, you feel an increased urge to go so you head to the bathroom, sit down, let your pelvic floor relax and allow your bladder to empty. However, if you interrupt the steam of urine by contracting the pelvic floor, your detrusor muscle relaxes and this tells your body, ok now it’s time to be done.
By changing what is contracting and relaxing, you can confuse the communication between your pelvic floor and bladder. This may lead to incomplete bladder emptying and urinary retention which could lead to urinary tract infection. The confusion may also lead you to having a more difficult time fully relaxing your pelvic floor and letting go while on the toilet. This could further lead to a chronically contracted pelvic floor which decreases its ability to effectively contract and relax in a healthy manner, potentially leading to a slew of other issues such as increased urinary leakage or pain with sexual intimacy and/or intercourse. Additionally, it may also lead to increased urinary urgency since your bladder is confused; it’ll be wondering should I contract or should I relax; is it time to go or not?
I would also like to note that Kegels should be used as a part of a prescribed exercise program and are not appropriate for everyone. The pelvic floor is a group of muscles and, just like other muscles in the body, if it’s overly contracted and shortened, you don’t want to further shorten it. If you start strengthening a chronically contracted muscle, it can actually have negative effects and worsen pelvic floor dysfunction. You should first focus on regaining proper length and flexibility within the tissues. Once you are able to effectively relax and lengthen your pelvic floor, you can then progress to improving coordination and strength. So, if you are unsure whether your pelvic floor is giving you trouble because it is overly contracted or not contracting enough, it’s a good idea to check in with your pelvic physical therapist to ensure that you have a plan specifically tailored to your needs.
So what's the moral of the story? It is important to be able to control your pelvic floor and successfully do Kegels or pelvic floor contractions just as it’s important to be able to relax your pelvic floor. However, practicing while you are urinating is not the answer; it will only confuse your body. If you would like to practice, practice whilst not on the toilet. You can imagine you are stopping the flow of urine or even imagine that you are, for example, sucking up a smoothie through your urethra, vagina and/or rectum.
When doing Kegels, it is important to remember how the pelvic floor and diaphragm are related. As you breathe in, your diaphragm pulls air down into your lungs. During that inhale, the pelvic floor should be relaxed and elongate slightly so that it is moving in rhythm with the diaphragm. As you exhale, the pelvic floor will return to its resting tone and you can add a little pelvic floor contraction which pairs nicely with some light abdominal activation at the end of the exhale. Keep in mind, only add the Kegel with exhale while you are doing the exercise. You should by no means be Kegeling with every exhale throughout the day just as you wouldn’t do another exercise such as squats all day long.
Check out this video on how to Kegel properly:
If you are experiencing pelvic floor dysfunction such as urinary leakage, increased urinary urgency or frequency, incomplete emptying, pelvic pain or vaginal heaviness/bulging and would like to learn more about pelvic floor relaxation and contraction and how to safely and practically use the two, I encourage you to contact a pelvic health therapist.
Check out our Pelvic Health page to learn more about how a physical therapist can help you overcome pelvic floor dysfunction.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
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Chancellor MB, Blaivas JG, editors. Practical Neurourology: Genitourinary Complications in Neurologic Disease. Stoneham, Mass: Butterworth-Heinemann; 1995.
Fitz F, Sartori M, Girão MJ, Castro R. Pelvic floor muscle training for overactive bladder symptoms - A prospective study. Rev Assoc Med Bras (1992). 2017 Dec;63(12):1032-1038.